Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin Lung Cancer. 2017 Nov;18(6):e375-e383. doi: 10.1016/j.cllc.2017.03.008. Epub 2017 Mar 16.
The development of immune checkpoint inhibitors against programmed death 1 has paved the way for a new era of treatment of lung cancer. Programmed death-ligand 1 (PD-L1) is expected to predict the response of immune checkpoint inhibitors in lung cancer. Predicting PD-L1 expression using a noninvasive method before immunotherapy would, therefore, help identify patients for whom immunotherapy can be successful.
A total of 394 patients with resected lung adenocarcinoma who had undergone preoperative thin-section computed tomography (CT) were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and CT characteristics, including convergence, surrounding ground glass opacity (GGO), air bronchogram, notching, pleural indentation, spiculation, and cavitation.
Of the 394 patients, 78 (19.8%) were positive and 316 (80.2%) were negative for PD-L1 expression. Univariate analysis demonstrated that PD-L1 adenocarcinoma was significantly associated with the presence of convergence (P < .01), notching (P < .01), spiculation (P < .01), and cavitation (P < .01) and the absence of surrounding GGO (P < .01) compared with PD-L1 cases. On multivariate analysis, the presence of convergence (P < .01) and cavitation (P < .01) and the absence of surrounding GGO (P = .02) and air bronchogram (P = .03) were significantly associated with PD-L1 expression.
PD-L1 adenocarcinoma cases showed convergence and cavitation more frequently than did PD-L1 cases. In contrast, surrounding GGO and air bronchogram were observed less frequently in PD-L1 cases than in PD-L1 cases. These results will prove helpful in identifying PD-L1-expressing adenocarcinoma by CT before immunotherapy.
针对程序性死亡 1 的免疫检查点抑制剂的开发为肺癌治疗开辟了一个新时代。程序性死亡配体 1（PD-L1）有望预测肺癌免疫检查点抑制剂的反应。因此，在免疫治疗前使用非侵入性方法预测 PD-L1 表达将有助于识别免疫治疗可能成功的患者。
共分析了 394 例接受术前薄层 CT（CT）检查的肺腺癌患者的 PD-L1 表达情况，通过免疫组织化学进行评估，并确定 PD-L1 表达与 CT 特征之间的关系，包括汇聚、周围磨玻璃密度（GGO）、空气支气管征、切迹、胸膜凹陷、分叶和空洞。
394 例患者中，78 例（19.8%）为 PD-L1 阳性，316 例（80.2%）为 PD-L1 阴性。单因素分析表明，与 PD-L1 阳性相比，PD-L1 腺癌与汇聚（P<.01）、切迹（P<.01）、分叶（P<.01）和空洞（P<.01）的存在以及周围 GGO（P<.01）的存在显著相关。多因素分析显示，汇聚（P<.01）和空洞（P<.01）的存在以及周围 GGO（P=.02）和空气支气管征（P=.03）的缺乏与 PD-L1 表达显著相关。
PD-L1 腺癌病例比 PD-L1 病例更频繁地出现汇聚和空洞。相反，与 PD-L1 病例相比，周围 GGO 和空气支气管征在 PD-L1 病例中较少见。这些结果将有助于在免疫治疗前通过 CT 识别 PD-L1 表达的腺癌。
